atrial fibrillation
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2011 Sep 15;365(11):981-92 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral factor Xa inhibitors, apixaban, 5 mg twice daily
As Treatment, Chronic
Is better Than
warfarin
To reduce stroke or systemic embolism at 1.8 years (1.3% apixaban VS 1.6% warfarin) witout increasing major bleeding (2.1% apixaban VS 3.1% warfarin). Quite similar rate of all-cause death (3.5% apixaban VS 3.9% warfarin)
JAMA Intern Med. 2017 Apr 01;177(4):563-570 Cohorts
IN stroke, haemorrhagic, intracerebral hemorrhage, traumatic, patients with atrial fibrillation The Use of
resuming warfarin afterwards
As Treatment, Chronic
Is better Than
definitively stopping warfarin, no oral anticoagulant treatment
To reduce at 1 year stroke or systemic embolism (HR 0.5 warfarin) but increasing recurrent intracranial HRR (HR 1.3) with a final reduction in overall mortality (HR 0.5 in stroke HRR, HR 0.35 in traumatic HRR with warfarin)
Am J Med. 2010 Jul;123(7):638-645.e4 Systematic Review
IN anticoagulants, vitamin K antagonists, atrial fibrillation The Use of
frequency of use of anticoagulants, vitamin K antagonists
As Treatment, Chronic
Is worse Than
frequency of use recommended by guidelines
To oral anticoagulants are largely underused in patients with AF and previous AIT or stroke (<70% patients anticoagulated in 25/29 studies, range 19-81%)) or CHADS2 > 2 (<70% patients anticoagulated in 7/9 studies, range 39-92%)
N Engl J Med. 2015 Aug 27;373(9):823-33 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, atrial fibrillation, periprocedure interruption of anticoagulation The Use of
no bridging anticoagulation, just stopping warfarin 5 days before the procedure and resuming it within 24 hours afterwards
As Treatment, Acute
Is better Than
bridging anticoagulation with full-dose low-molecular-weight heparin (LMWH)
To avoid major bleeding (1.3% just stop Vs 3.2% bridging) while having similar incidence of arterial thromboembolism (0.4% just stop VS 0.3% bridging)
J Am Coll Cardiol. 2005 Jun 7;45(11):1832-9 Meta-Analysis
IN atrial fibrillation The Use of
angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of new onset atrial fibrillation (most cumulated studies: RRR of 28%) and reduce its recurrence after conversion (2 studies)
N Engl J Med. 2011 Mar 10;364(10):928-38 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation The Use of
angiotensin II receptor blockers, irbesartan
As Treatment, Chronic
Is equal Than
placebo
To reduce at 4 years cardiovascular events (stroke, myocardial infarction, or death): 5.4% per years in both groups. Neither it reduced AF recurrences in patients in sinus rhythm at baseline
N Engl J Med. 2011 Sep 8;365(10):883-91. Epub 2011 Aug 10 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban, 20 mg once daily
As Treatment, Chronic
Is equal Than
dose-adjusted warfarin
To reduce stroke or systemic embolism (2.1% per year rivaroxaban VS 2.4% warfarin), or cause clinically relevant bleeding, major or nonmajor (15% per year both)
Stroke. 2009 Apr;40(4):1410-6 Meta-Analysis
IN atrial fibrillation, anticoagulants, vitamin K antagonists, bleeding risk, elder patients, stroke, ischemic, cerebral infarction, embolic The Use of
age
As Etiologic risk factor
Is useful Than
-
To predict an increased risk of stroke (HR per decade 1.45), major bleeding (HR per decade 1.61) and cardiovascular events (HR per decade 1.45). However the relative benefit of warfarin for preventing stroke persisted, while that of aspirin decreased
Lancet. 2007 Aug 11;370(9586):493-503 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, elder patients, not high haemorrahgic risk, not high stroke risk, anticoagulants, vitamin K antagonists, bleeding risk, elder patients The Use of
warfarin, antivitamin K
As Treatment, Chronic
Is better Than
aspirin
To reduce all-type strokes: 1.8% warfarin versus 3.8% aspirin. No increase at all in major haemorrhages.
N Engl J Med. 2004 Dec 2;351(23):2373-83 Clinical Trial (non-controlled, non-randomized)
IN atrial fibrillation, heart failure, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is good Than
no comparison group in this trial
To restore and maintain sinus rhythm: after 12 months 70% of patients maintained SR. Improve ejection fraction in those patients with heart failure (average of plus 20% at 12 months)
N Engl J Med. 2018 02 01;378(5):417-427 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, heart failure, reduced ejection fraction, non-pharmacological treatment The Use of
catheter ablation
As Treatment, Acute
Is better Than
medical-therapy only
To reduce mortality from any cause (13%] ablation VS 25%), hospitalization for worsening heart failure (21% ablation VS 36%) or death from cardiovascular causes (11% ablation VS 22%)
Circulation. 2007 Jun 19;115(24):3050-6 Cohorts
IN atrial fibrillation, lone (no structural heart disease) The Use of
knowing natural history
As Prognostic Item
Is useful Than
no comparison here
To predict long-term (30 years) evolution : 30% progressed to permanent AF, mortality similar to general population, heart failure and stroke more frequent than general pop. but less than other AF, linked to HTA and comorbidities.
Circulation. 2011 May 31;123(21):2363-72 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, anticoagulants, oral direct thrombin inhibitors, risk of bleeding, elder patients The Use of
oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose
As Treatment, Chronic
Is equal Than
warfarin
To risk of major bleeding, in patients >75 years, with the 110mg dose (4.43% dabigatran VS 4.37% warfarin) but a trend to more bleedings with 150mg dose (5.1% dabigatran versus 4.4% warfarin). Both doses had less bleedings in <75 years old
Eur Heart J. 2016 May 21;37(20):1582-90 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
a new stroke risk score: ABC (Age, Biomarkers, Clinical history) combining: age, NT-proBNP, high-sensitivity troponine, prior stroke/transient ischaemic attack
As Prognostic Item
Is better Than
CHA2DS2-VASc score
To better predict the risk of stroke at a mean 2 years follow-up (c-indice 0.66 ABC vs. 0.58 CHA2DS2-VASc)
Am J Cardiol. 2012 Aug 1;110(3):453-60. Epub 2012 Apr 24 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To decrease risk for all-cause stroke and systemic embolism (RR 0.78) and all-cause mortality (RR 0.88), while reducing risk of intracranial bleeding (RR 0.88) but not of all major bleeding
J Am Coll Cardiol. 2012 Aug 21;60(8):738-46. Epub 2012 May 9 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is equal Than
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
To modify the risk of stroke and systemic embolism (no significant differences between drugs). Apixaban seemed to have less major bleedings than dabigatran 150mg or rivaroxaban (RR 0.74 and 0.66)
Canadian Agency for Drugs and Technologies in Health - CADTH. 2013 Mar: 1(1B); 1-142 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, antiplatelet drugs, aspirin, clopidogrel
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin, aspirin
To modify stroke, embolism or bleedings : there are some differences in some cases but with little absolute risk reduction
Lancet. 2014 Mar 15;383(9921):955-62 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To reduce reduced stroke or embolic events (RR 0.81), mainly driven by a reduction in haemorrhagic stroke (RR 0.49). New oral anticoagulants also reduced all-cause mortality (RR 0.90) but increased gastrointestinal bleeding (RR 1.25)
N Engl J Med. 2009 Sep 17;361(12):1139-51. Epub 2009 Aug 30 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
oral direct thrombin inhibitors, dabigatran, 110 or 150 mg twice daily fixed dose
As Treatment, Chronic
Is better Than
warfarin, INR adjusted dose
To reduce at 2 years ischemic strokes (1.53% - 1.11% per year 110 - 150 mg dabigatran VS 1.69% warfarin), with similar major bleedings (2.71% - 3.36% per year) and less haemorrhagic strokes (0.10% per year dabigatran VS 0.38% warfarin)
J Am Coll Cardiol. 2015 Jun 23;65(24):2614-23 Meta-Analysis
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
percutaneous left atrial appendage closure
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin
To lodify all cause stroke or systemic embolism per year: 1.75% closure VS 1.87 warfarine. More ischemic but less hemorrhagic strokes with the device. Device had also less nonprocedural bleedings.
Cochrane Database Syst Rev. 2018 Mar 06;3:CD008980 Systematic Review, Cochrane Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, all-cause mortality The Use of
direct oral anticoagulants, oral factor Xa inhibitors, apixaban, edoxaban, rivaroxaban, idraparinux
As Treatment, Chronic
Is better Than
oral anticoagulants, vitamin K antagonists, warfarin
To Results to be defined
Circulation. 2014 Jul 8;130(2):138-46 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, older patients The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban
As Treatment, Chronic
Is equal Than
vitamine K antagonists, warfarin
To modify, in patients > 75 years, stroke (2.29% rivaroxaban VS 2.85% warfarin per 100 patient-years) or major bleeding (4.86% rivaroxaban versus 4.40% warfarin per 100 patient-years). Older patients had more strokes and major bleedings than young ones
N Engl J Med. 2011 Mar 3;364(9):806-17. Epub 2011 Feb 10 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, patients not suitable for vitamine K antagonists, warfarin The Use of
anticoagulants, oral factor Xa inhibitors, apixaban
As Treatment, Chronic
Is better Than
aspirin
To reduce stroke or systemic embolism (1.6% per year apixaban VS 3.7% aspirin) while not increasing major bleeding (1.4% per year apixaban VS 1.2% aspirin)
Ann Intern Med. 2012 Dec 4;157(11):796-807 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, thromboembolic disease The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
anticoagulants, antivitamine K, warfarin
To reduce mortality in atrial fibrillation (RR 0.88) but not in venous thromboembolism. Fatal bleeding was reduced (RR 0.60) but not major bleeding and bleeding risk may be increased in older people
Circulation. 2015 Jul 21;132(3):194-204 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic, thromboembolic disease, old patients The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, edoxaban
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin
To reduce thrombo-embolic events, but with different bleeding patterns: dabigatran was associated with a higher risk of gastrointestinal bleeding, risk of intracranial bleeding was lower, apixaban and edoxaban associated lower risk of major bleedings
Arch Intern Med. 2008 Mar 24;168(6):581-6 Systematic Review
IN atrial fibrillation, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
cardioversion and chronic antiarrhythmic drugs
To reduce at 1 year recurrence of AF (24.% abalation VS 81.2% antiarrhythmics) and reduce adverse events. No other clinical outcome assessed (mortality? heart failure?)
Circ Arrhythm Electrophysiol. 2014 Oct;7(5):853-60 Systematic Review
IN atrial fibrillation, non-pharmacological treatment, selected patients The Use of
catheter ablation
As Treatment, Acute
Is better Than
cardioversion and chronic antiarrhythmic drugs
To recurrence of AF (28% ablation VS 65% antiarrhythmics), either as firts-line or second-line therapy
N Engl J Med. 2009 Apr 16;360(16):1606-17 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal The Use of
angiotensin II receptor blockers (ARB), valsartan
As Prevention, Secondary
Is equal Than
placebo
To reduce recurrences of AF: 51.4% valsartan VS 52% placebo.
JAMA. 2005 Jun 1;293(21):2634-40 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, paroxysmal, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
chronic antiarrhythmic drug therapy
To reduce symptomatic AF recurrence (13% with ablation VS 63% with drugs) and hospitalizations (9% VS 54%). Pulmonary vein stenosis in 6% patients with ablation.
J Am Coll Cardiol. 2006 Dec 5;48(11):2340-7 Randomized Controlled Trial
IN atrial fibrillation, paroxysmal, refractory, non-pharmacological treatment The Use of
catheter ablation, circumferential pulmonary vein ablation
As Treatment, Chronic
Is better Than
change to another antiarrhythmic drug
To reduce, at 1 year, recurrences of AF: 7% with ablation VS 65% with drugs. Ablation was repeated in 9% patients and 2 severe adverse effects.
N Engl J Med. 2010 Apr 15;362(15):1363-73 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, permanent, rate control strategy The Use of
lenient rate control (resting heart rate <110 beats/min)
As Treatment, Chronic
Is equal Than
strict rate control (resting heart rate <80 beats/min and during moderate exercise <110 beats/min)
To modify at 2 years a composite of cardiovascular events: 12.9% lenient VS 14.9% strict (NS). Symptoms and adverse effects were also similar.
Heart. 2008 Feb;94(2):191-6. Epub 2007 May 4 Cohorts
IN atrial fibrillation, persistent The Use of
digitalis, digoxin
As Treatment, Chronic
Is worse Than
other rate control drugs
To modify mortality: 6.5% digitalis VS 4.1% non-digitalis, HR 1.53 after adjustement for other risk factors
J Am Coll Cardiol. 2005 Mar 1;45(5):705-11 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, hypertension, primary The Use of
angiotensin II receptor blockers, losartan
As Treatment, Chronic
Is better Than
beta-blockers
To reduce cardiovascular events (composite of cardiovascular mortality, stroke, and myocardial infarction): 36/171 patients with losartan VS 67/171 patients with B-blokers, at aprox 4 years
JAMA. 2005 Feb 9;293(6):690-8 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, direct thrombin inhibitors, ximelagatran
As Treatment, Chronic
Is equal Than
warfarin
To prevent, at 20 months, stroke (of any type): 1.6% xime. VS 1.2% warf. Elevated liver enzymes (>3N): 6% xime. VS 0.8% warf. Major bleeding similar. Finally dropped due to hepatic toxicity.
N Engl J Med. 2006 Mar 2;354(9):934-41 Randomized Controlled Trial
IN atrial fibrillation, persistent, non-pharmacological treatment The Use of
catheter ablation, radiofrequency
As Treatment, Acute
Is better Than
cardioversion and chronic amiodarone
To reduce atrial fibrillation recurrence: 26% with ablation VS 42% amiodarone; and improve symptoms. Complications: atypical atrial flutter.
Arch Intern Med. 2005 Feb 14;165(3):258-62 Meta-Analysis
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To reduce all-cause mortality at 2 to 3.5 years: 14.6% rhythm-control vs 13.0% rate-control. A trend existed in favour of rate-control: OR 0.87; 95%CI 0.74-1.02
N Engl J Med. 2002 Dec 5;347(23):1834-40 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To reduce a composite of cardiovascular and treatment-related events: 17.2% in rate-control VS 22.6% in rhythm-control
Ann Intern Med. 2004 Nov 2;141(9):653-61 Cost-Effectiveness
IN atrial fibrillation, persistent, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To cost-effectiveness: rate control is always more effective and less costly
Ann Intern Med. 2005 Sep 6;143(5):327-36 Meta-Analysis
IN atrial fibrillation, postoperative, cardiac surgery The Use of
antiarrhythmics, amiodarone
As Prevention, Primary
Is better Than
placebo
To decrease the incidence of atrial fibrillation or flutter (RR 0.64), ventricular arrhythmia (RR 0.42) and stroke (RR 0.39)
Eur Heart J. 2006 Jul;27(13):1584-91. Epub 2006 Jun 7 Randomized Controlled Trial
IN atrial fibrillation, postoperative, cardiac surgery The Use of
prophylaxis using antiarrhythmics, amiodarone, 600 mg oral single dose per day from Day-1 to Day7 plus IV perfusion during surgery
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of post-operative AF: 85% with amiodarone VS 34% placebo. Also reduced hospitalization length of stay. Blood concentrations of amiodarone sig. differed between patients.
Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003611 Systematic Review, Cochrane Review
IN atrial fibrillation, postoperative, cardiac surgery The Use of
several antiarrhythmics (amiodarone, sotalol, beta-blockers) and pacing
As Prevention, Primary
Is better Than
placebo
To reduce the incidence of atrial fibrillation (OR between 0.26 and 0.49) and possibly (non significant) reduces stroke and lenght of stay
Pharmacotherapy. 2007 Mar;27(3):360-8 Meta-Analysis
IN atrial fibrillation, postoperative, cardiac surgery The Use of
amiodarone, total doses > 3 grs, starting before or after surgery
As Treatment, Acute
Is better Than
placebo
To reduce the incidence of post-operative atrial fibrillation (OR 0.50)
N Engl J Med. 2002 Dec 5;347(23):1825-33 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control
To reduce adverse drug effects and hospital admissions, while no difference in mortality (23.8% rate VS 21.3% rhythm control at 5 years)
Eur Heart J. 2005 Oct;26(19):2000-6. Epub 2005 May 4 Meta-Analysis
IN atrial fibrillation, rate control strategy The Use of
rate control strategy
As Treatment, Chronic
Is better Than
rhythm control strategy
To reduce a combined endpoint of all cause death and thromboembolic stroke (OR 0.84 (0.73, 0.98)). No difference in all-cause death, systemic embolism and major bleeding.
N Engl J Med. 2008 Jun 19;358(25):2667-77 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, rate control strategy, heart failure, chronic, systolic The Use of
rate control strategy
As Treatment, Chronic
Is equal Than
rhythm control strategy
To modify death from cardiovascular causes (25% rate-control VS 27% rhythm-control) or reduce stroke (4% rate-control VS 3% rhythm-control) or worsening heart failure (31% rate-control VS 28% rhythm-control)
Eur Heart J. 2006 Jan;27(2):216-21. Epub 2005 Oct 7 Randomized Controlled Trial
IN atrial fibrillation, refractory, non-pharmacological treatment The Use of
catheter ablation, radiofrequency AND and antiarrhythmic drugs (various)
As Treatment, Chronic
Is better Than
antiarrhythmic drug therapy alone (various drugs)
To prevent AF recurrence: 44% with ablation VS 91% without. Three (4.4%) major complications were related to ablation: stroke, pericardial effusion and a phrenic paralysis.
Arch Intern Med. 2006 Apr 10;166(7):719-28 Systematic Review
IN atrial fibrillation, rhythm control strategy The Use of
antiarrhythmic drugs, classes IA, IC, III
As Treatment, Chronic
Is worse Than
placebo or no treatment
To reduce mortality, class IA drugs (quinidine, dysopiramide) increased mortality (NNH 109) and the rest did not modify it. All drugs increased adverse effects and pro-arrhythmia (but amiodarone).
N Engl J Med. 2009 May 14;360(20):2066-78 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin
As Treatment, Chronic
Is better Than
aspirin alone
To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Lancet. 2006 Jun 10;367(9526):1903-12 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin (75-100 mg/day)
As Treatment, Chronic
Is worse Than
oral anticoagulation (target INR 2.0-3.0)
To prevent embolic events (stroke, non-CNS systemic embolus, myocardial infarction, or vascular death): annual risk 3.93% with warfarin VS 5.60% with aspirin plus clopidogrel
J Am Geriatr Soc. 2014 May;62(5):857-64 Meta-Analysis
IN atrial fibrillation, thromboembolic disease, old patients, anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban
As Treatment, Chronic
Is better Than
warfarin
To prevent stroke or VTE recurrence: no numbers given in abstract
N Engl J Med. 2017 Oct 19;377(16):1513-1524 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with dabigatran 110 mg twice daily plus an a P2Y12inhibitor (clopidogrel or ticagrelor) antiplatelet
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet
To reduce at 14 months major or clinically relevant bleeding events (15% dabigatran 110mg VS 27% triple therapy) with no increase of cardiovascular events (13.7% dual-therapy VS 13.4% triple-therapy)
Lancet. 2013 Mar 30;381(9872):1107-15 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
dual treatment with INR adjusted warfarin plus clopidogrel
As Treatment, Chronic
Is better Than
triple therapy with dose-adjusted vitamin K antagonist plus dual antiplatelet (aspirin + clopidogrel)
To reduce at 1 year any bleeding event (19% dual Tt VS 44% triple Tt) with no increase in the rate of thrombotic events
N Engl J Med. 2016 Dec 22;375(25):2423-2434 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents, atrial fibrillation The Use of
low-dose rivaroxaban (15 mg /d) plus an P2Y12 inhibitor antiplatelet for 12 months OR very-low-dose rivaroxaban (2.5 mg twice daily) plus dual antiplatelet for 1, 6, or 12 months
As Treatment, Chronic
Is better Than
dose-adjusted vitamin K antagonist plus dual antiplatelet for 1, 6, or 12 months
To reduce clinically significant bleeding (17% rivaroxaban 15 + 1 antiplatelet, 18% rivaroxaban 2.5 + 2 antiplatelets, and 26.7% antivitamin K + 2 antiplatelets) while having similar rates of cardiovascular events (6.5%, 5.6% and 6% respectively)
Circulation. 2014 Apr 15;129(15):1577-85 Cohorts
IN coronary disease, stable, atrial fibrillation The Use of
anticoagulation alone, vitamin K antagonists
As Treatment, Chronic
Is equal Than
bi-therapy combining anticoagulant (vitamin K antagonist) + an antiplatelet
To modify at 3 years the risk of myocardial infarction, cardiac death or thromboembolism, while the risk of bleeding was higher with bi-therapy (HR 1.5)
Arch Intern Med. 2007 Jan 22;167(2):117-24 Meta-Analysis
IN heart valve disease, mechanical heart valve, atrial fibrillation, coronary disease The Use of
aspirin, added to vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
vitamin K antagonists, warfarin, alone
To reduce arterial thromboembolism, but only in patients with mechanical heart valve (OR 0.27) and not for coronary disease or atrial fibrillation. There was not differences in all-cause mortality and major bleeding was higher (OR 1.43)
J Am Coll Cardiol. 2005 Mar 1;45(5):712-9 Randomized Controlled Trial, Multicenter Study
IN hypertension, primary, ventricular hypertrophy, atrial fibrillation The Use of
angiotensin II receptor blockers, losartan
As Treatment, Chronic
Is better Than
beta-blockers
To prevent development of new-onset atrial fibrillation: AF occurred in 6.8/1,000 person-years with losartan VS 10.1 with B-blockers.
Stroke. 2007 Nov;38(11):2935-40 Diagnostic
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation The Use of
noninvasive cardiac monitoring, Holter ECG monitoring, event loop recording
As Diagnostic Tool
Is bad Than
no comparison here
To detect new atrial fibrillation: in 4.6% of consecutive patients with ischemic stroke
JAMA. 2002 Nov 20;288(19):2441-8 Meta-Analysis
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
aspirin
To decrease stroke (of any type): 2.4% per year with warfarin VS. 4.5% with aspirin. But modestly increased major bleeding: 2.2 VS. 1.3% per year. Overall all-cause mortality did not differ
Lancet. 1994 Mar 19;343(8899):687-91 Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is equal Than
aspirin
To prevent stroke, when considered all types of stroke. Disabling stroke happened in 4.3% older patients with aspirin VS 4.6% with warfarin (per year). Warfarin was better to decrease ischemic stroke in patients > 75 years old
Cochrane Database Syst Rev. 2005 Jul 20;(3):CD001927 Systematic Review, Cochrane Review
IN stroke, ischemic, cerebral infarction, embolic, atrial fibrillation, non valvular The Use of
vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
no anticoagulant nor antiaggregant treatment
To reduce all strokes (ARR 2.5% per year), reduce disabling or fatal stroke (ARR 1.2% per year) and reduce death (OR 0.69)
N Engl J Med. 2014 Jun 26;370(26):2478-86 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, transient ischemic attack, cryptogenic, embolic, atrial fibrillation The Use of
insertable cardiac monitor (96% of patients kept it after 12 months)
As Diagnostic Tool
Is better Than
conventional ECG follow-up at the discretion of usual doctor
To detect atrial fibrillation at 12 months : 12% of patietns with insertable monitor VS 2% in controls. Insertable monitors had to be removed in 2.4% patients because infection or local inflammation.
N Engl J Med. 2014 Jun 26;370(26):2467-77 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, transient ischemic attack, cryptogenic, embolic, atrial fibrillation The Use of
ambulatory ECG monitoring with a 30-day event-triggered recorder (attached to a dry-electrode (nonadhesive) belt worn around the chest)
As Diagnostic Tool
Is better Than
ambulatory 24-hour ECG monitoring
To detect atrial fibrillation episodes at 3 months : 16% in 30-days monitoring VS 3% with 24-hour monitoring